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Individual

CHRISTINE JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
65 EAST 100 NORTH, GUNNISON, UT 84634-0759
(435) 528-2130
(435) 528-2197
Mailing address
1055 N 500 W, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2870211205
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
870212456036
UT
05
DO972
UT
Enumeration date
12/11/2006
Last updated
01/17/2013
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